African-American Women and Older Patients Are at Risk for a Greater Decline in Renal Function Following Living Kidney Donation

Abstract

Living donor kidney transplantation offers many advantages to the recipients. Longer allograft survival, fewer postoperative complications, and better renal function are some of the benefits of receiving living donor kidneys compared to deceased donor organs. However, the consequences to the donor in terms of renal function are not as well defined. Moreover, it is not clear whether all donors share an equal risk to their renal function following donation regardless to ethnicity, sex, and age. In this retrospective study, we identify and compare the reduction in estimated glomerular filtration rate (eGFR) among ethnic groups, women, and older donors prior to, immediately after, and 1 year postdonation. We compared the percentage decline in renal function among various ages and other demographic groups using individual patients as their own controls. Medical records of 103 consecutive living donors (mean age 40.3 ± 9.6 years) were reviewed. On average, donors experienced a 34.7% fall in eGFR at 273 days posttransplant. A greater decline was noticed in the African-American (AA) group (41% compared to 34% in white patients, P = .03). The majority of the decline in the AA eGFR was among women, in whom the fall was 46% compared to AA men at 31%. White women had a 34% fall in eGFR ( P = .02). The percentage decline in eGFR was not different among the different age groups; however, donors older than 50 years had a postdonation eGFR of 55.1 mL/min versus 60.9 mL/min in those less than 50 years old ( P = .03), reflecting lower eGFR predonation (older 84.7 mL/min vs younger 95.2 mL/min, P = .02). The percent decline in eGFR did not change with time after donation (0–1 month 37%, 1–12 months 34%, >1 year 30%). eGFR declines abruptly post–kidney donation in all patients but remains stable and improves afterwards. AA women and older donors are more prone to reduction in eGFR post–kidney donations.